Mental-Health Rights Movement

In her article on the de-institutionalization of the mentally ill, (Commentary, Dec. 15) Rael Jean Isaac appears to be curiously uninformed about the mental-health rights movement in the United States. Either that or she has set up a straw man in the form of R.D. Laing in order to avoid dealing with the real issues in mental health, which is, of course, money.

As someone who was involved in the mental-health rights movement of the early 1970s and who knows many of the far more active and important participants, I can say that Isaac has totally missed all the key points of that movement. Some activists, of course, were influenced by Laing. For most of us, however, the issues were quite different.

There were really three key issues. One was the abominable condition of mental-health facilities around the country. Many facilities had no professional staff caring for the patients and provided no treatment except for the joke called milieu therapy. The physical structures housing the mentally ill and retarded were ancient and dilapidated, the food inadequate, recreational space close to nonexistent.

The second key issue involved who was committed and how. Procedures for commitment were so loose that people could be and were committed who met no one’s definition of insanity. Courts and legislatures were willing to deal with procedural issues but not willing in many instances to do anything about the conditions.

Nonetheless, in bringing this litigation it was not anyone’s expectation that the mentally ill would roam the Skid Rows of this country, uncared for. For one thing, it now turns out that advocates for the mentally ill had unreasonable expectations about the ability of the various psychotropic drugs to help people lead more mainstream lives. In many cases, these drugs produce side effects worse than any condition they might cure. This, of course, has given rise to the third key issue, the right to refuse often dangerous treatment.

In any event, advocates for the mentally ill believed, at least for a while that as patients were de-institutionalized, the states, with federal help, would develop a network of community mental-health centers that would assist and support the former patients in becoming part of the community. However, this network was only partially developed and in the ‘80s allowed to disintegrate. Most former patients have never received the support they would need to move off Skid Row.

The real problem is that a good mental-health system costs substantially more money than government is willing to put into it. But we are no longer a society that wants to resolve social problems, if it involves doing more than throwing people into a horrendously under-funded criminal justice system.

STANTON J. PRICE

Santa Monica